Abstract
BackgroundIn Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it. In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without specialized virologic testing can be a complex process. We aimed to introduce an Early Infant Diagnosis (EID) pilot program using HIV DNA Polymerase Chain Reaction (PCR) testing with the intent of making EID nationally available based on lessons learned in the first 6 months of implementation.MethodsIn September 2006, a molecular biology laboratory at Bugando Medical Center was established in order to perform HIV DNA PCR testing using Dried Blood Spots (DBS). Ninety- six health workers from 4 health facilities were trained in the identification and care of HIV-exposed infants, HIV testing algorithms and collection of DBS samples. Paper-based tracking systems for monitoring the program that fed into a simple electronic database were introduced at the sites and in the laboratory. Time from birth to first HIV DNA PCR testing and to receipt of test results were assessed using Kaplan-Meier curves.ResultsFrom October 2006 to March 2007, 510 HIV-exposed infants were identified from the 4 health facilities. Of these, 441(87%) infants had an HIV DNA PCR test at a median age of 4 months (IQR 1 to 8 months) and 75(17%) were PCR positive. Parents/guardians for a total of 242(55%) HIV-exposed infants returned to receive PCR test results, including 51/75 (68%) of those PCR positive, 187/361 (52%) of the PCR negative, and 4/5 (80%) of those with indeterminate PCR results. The median time between blood draw for PCR testing and receipt of test results by the parent or guardian was 5 weeks (range <1 week to 14 weeks) among children who tested PCR positive and 10 weeks (range <1 week to 21 weeks) for those that tested PCR negative.ConclusionsThe EID pilot program successfully introduced systems for identification of HIV-exposed infants. There was a high response as hundreds of HIV-exposed infants were registered and tested in a 6 month period. Challenges included the large proportion of parents not returning for PCR test results. Experience from the pilot phase has informed the national roll-out of the EID program currently underway in Tanzania.
Highlights
In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it
Until recently laboratory capacity for program-level Polymerase Chain Reaction (PCR)-based assays has been limited in Sub-Saharan Africa and lacking in Tanzania, resulting in a significant barrier to early infant diagnosis (EID) and timely initiation of ART in HIV-infected infants [10]
We introduced a pilot Early Infant Diagnosis (EID) program in the Lake region of Tanzania (Figure 1) aiming to establish laboratory capacity and infrastructure to perform HIV DNA PCR testing; and to develop clinical infrastructure and systems to support identification, care and follow-up of HIV-exposed infants in both remote rural and moderately urban settings
Summary
In Tanzania, less than a third of HIV infected children estimated to be in need of antiretroviral therapy (ART) are receiving it In this setting where other infections and malnutrition mimic signs and symptoms of AIDS, early diagnosis of HIV among HIV-exposed infants without specialized virologic testing can be a complex process. We aimed to introduce an Early Infant Diagnosis (EID) pilot program using HIV DNA Polymerase Chain Reaction (PCR) testing with the intent of making EID nationally available based on lessons learned in the first 6 months of implementation. We introduced a pilot EID program in the Lake region of Tanzania (Figure 1) aiming to establish laboratory capacity and infrastructure to perform HIV DNA PCR testing; and to develop clinical infrastructure and systems to support identification, care and follow-up of HIV-exposed infants in both remote rural and moderately urban settings. We report on the experience of developing and establishing the EID program, describe the characteristics of children served, and report on successes and challenges of the pilot phase in order to inform the on-going scale up of EID services in Tanzania and Sub-Saharan Africa
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